Pueblo West Metropolitan District Citizen's Academy Application for Admission

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Pueblo West Metropolitan District Citizen's Academy Application for Admission

First Name*

Last Name*

Phone Number*

Email Address*

Driver's License Number & State*

Address*

City*

State*

Zip Code*

Have you ever been charged or convicted of a felony?*

Have you been convicted of a crime including Domestic Violence, other than a minor traffic offense?*

If you answered yes to either of these questions regarding criminal charges or convictions, please explain:

How did you hear bout the Citizen's Academy?

I would like to attend the Citizen's Academy because:*

I understand that Pueblo West Metro may conduct a criminal background investigation check on each applicant.

T-shirt size:

In order to have the greatest impact on the community, it is necessary that those citizens that participate in the Citizen’s Academy are fully committed. We ask that participants interested in the Academy agree to attend every session of the Academy, barring extenuating circumstances.

I certify that the information contained in the forgoing application is true and correct to the best of my/our knowledge and belief; that I/we have read, understand and agree to abide by the requirements, rules and regulations governing the Citizen’s Academy in Pueblo West Metropolitan District. I agree to comply with all other requirements of the City, County, State, Federal Government, and any other applicable entity which may pertain to my participation in the Academy. I hold Pueblo West Metro and all its entities harmless against all liability.*